191503832-8-6-2021-33-CC-MGAA-C5MUEK-20210806153116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191503832
Report Date: 08/06/2021
Date Signed: 08/06/2021 03:32:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MONTEREY PARK CHRISTIAN SCHOOL		FACILITY NUMBER:	191503832
ADMINISTRATOR:	VERONICA TOLOSA		FACILITY TYPE:	850
ADDRESS:	1951 SOUTH GARFIELD AVE		TELEPHONE:	(323) 890-4545
CITY:	MONTEREY PARK	STATE: CA	ZIP CODE:	91754
CAPACITY:	76	CENSUS: 0	DATE:	08/06/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:32 PM
MET WITH:	Sandra Wong, Executive Director		TIME COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 6, 2021 at 2:32 p.m., Licensing Program Analyst (LPA) Mireya García contacted the Executive Director, Sandra Wong via telephone due to COVID 19 and precautionary measures in order to conduct a Case Management inspection due to an incident that was reported to the Department on July 26, 2021. LPA Garcia discussed the purpose of the call and conducted this inspection with Executive Director, Sandra Wong. At 2:34 p.m., the call was transferred into a FaceTime tele-inspection. During this tele-inspection, Executive Director, took LPA García on a virtual tour of the facility. There were no day care children present during this inspection. On July 26, 2021 an unusual incident report was made to the department regarding an incident that involved a child who sustained injury that required medical attention. The facility reported this incident to the Department within the required 24 hours. Based on information obtained during interviews conducted with staff and the parent of child in question, LPA Garcia determined that during outdoor play child fell and hit the forehead on the edge of the climbing structure steps. Although staff was present and observed the incident, staff could not reach the child in time to prevent fall. During this tele-visit LPA did not observe any tripping hazards near or on the area where incident took place. Child was taken to the doctor and received stiches. Child has returned to day care. REPORT CONTINUES ON NEXT PAGE 1 OF 2.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTEREY PARK CHRISTIAN SCHOOL	FACILITY NUMBER: 191503832
	VISIT DATE: 08/06/2021

NARRATIVE

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Based on information obtained during this investigation, no follow up is necessary regarding the incident reported. The facility followed all proper procedures; Staff administered first aid, child’s parent was notified, incident report was sent in properly and timely and all medical needs were met. Per Executive Director, staff will remind children to use handrails when going up the steps of the climbing structure to prevent falls in the future.

A Notice of Site Visit was not provided to Executive Director, Sandra Wong, since a physical inspection was not conducted.

Exit interview was conducted with Executive Director, Sandra Wong, via tele-inspection, during which Appeal Rights were verbally explained to Executive Director. A copy of this report (LIC 809) has been signed by LPA García. This report, along with a copy of the Appeal Rights (LIC 9058) will be scanned via e-mail to Executive Director, Sandra Wong, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. The facility representative was provided with the mailing address to the Monterey Park Regional Office (1000 Corporate Center Drive, Suite 200B, Monterey Park, CA 91754) and agrees to send a copy of the signed LIC 809 reports by email to LPA Garcia and mail originals forms to the office.

END OF REPORT: PAGE 2 OF 2

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

LIC809 (FAS) - (06/04)

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